Comprehensive Guide to Understanding Trauma and Treatment for Women
The vast majority of my clientele over the course of my career are survivors of some sort of trauma. Regardless of whether or not they have a PTSD (post-traumatic stress disorder) diagnosis or not, I find that they often have the same questions. So I wanted to write a comprehensive guide to help people better understand the impact of trauma and what the path to healing looks like. Whether you are a trauma survivor yourself, or you love someone who is, I hope you find this information validating and useful.
What is Trauma?
At its most basic level, trauma is an emotional and physical response to something terrible that has happened and that has jeopardized safety (physical and/or psychological). Psychological safety refers to the absence of a fear of harm and the ability to protect yourself from destructive impulses (either your own or someone else’s).
Examples of Things That Cause Trauma
natural disasters
any kind of abuse (physical, sexual, emotional)
childhood neglect
terrorism (including domestic terrorism, mass shootings, and that perpetuated by law enforcement)
being the victim of a crime
sexual assault
war
a serious car accident
medical trauma (like almost dying in childbirth or having a major heart attack)
Any trauma caused by another person you are in a relationship with, such as a partner, family member, or coworker, is known as interpersonal trauma. Intimate partner violence means experiencing physical, sexual, or emotional abuse from a partner. Anti-oppression providers also recognize oppression as a trauma. This is especially true because experiencing discrimination repeatedly threatens physical and psychological safety.
How Does A Trauma Therapist Diagnose PTSD?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition, TR) is the guide that contains the criteria providers use to make mental health diagnoses. It defines trauma for the purposes of a diagnosis of PTSD as follows:
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event
Witnessing, in person, the event as it occurs to others
Learning that the traumatic event occurred to someone close to you. In cases of actual or threatened death of a loved one, it must have been violent and accidental. Rather than more expected types of death such as from a known illness or injury.
Experiencing repeated or extreme exposure to aversive details of the traumatic event. For example, first responders on 9/11 who were exposed to remains and serious injuries. Or a doctor or detective who is repeatedly exposed to details of child sexual abuse.
It is important to note that there are serious and valid criticisms of the limits of the DSM definition of trauma (more on that below). But it is what trauma psychologists and other providers are required to use to make a diagnosis.
What’s also tricky is that the word “traumatic” is used often in colloquial language to describe anything painful, such as a breakup or discovering your partner is having an affair or losing your job. While these events are horrible and painful to experience, they generally aren’t considered traumas. Unless there are extenuating circumstances such as abuse or threats of abuse. In other words, it definitely hurts like hell when you get dumped, but it doesn’t necessarily threaten your physical or psychological safety.
Women’s Trauma Therapy Treatment & Oppression
We can’t talk about trauma without talking about oppression. As noted above, the DSM definition of trauma is lacking, to say the least. The experts who created it lack diversity and it makes no reference to experiences of oppression. Even though these experiences chip away at, and sometimes overtly threaten, physical and psychological safety. However, often people’s experiences of discrimination do meet DSM criteria, but a provider who is unaware of the impact of discrimination may miss this. So it is important to choose a provider who understands the impact of oppression. For example, being bullied or harassed because of a difference you have (being female, fat, trans, Black, etc.), either as a child or adult, can most definitely be threatening and create fear of harm. Even when no direct threat or physical harm occurs.
No matter what way you slice it, people in marginalized groups are far more likely to be impacted by trauma than folks in privileged groups. This is also a major reason why marginalized groups are more likely to have health problems, given the long-term impact of chronic stress on the body.
Sexism, Racism, Fatphobia, Classism, Transphobia, Heterosexism, Ableism, etc., all play a part in Trauma & PTSD
Trauma affects people from all walks of life. However, people who are women, transgender, BIPOC (Black, Indigenous, and people of color), dark complected, disabled, fat, lesbian, gay, bisexual, immigrant, old or young, less educated, Muslim, or living in poverty are all disproportionately impacted by trauma. Especially when compared to their White, wealthy, Christian, cisgender, light-skinned, able-bodied, thin, straight, educated, middle-aged, born in the USA, native English-speaking peers.
This impact is also intersectional (a term coined by Kimberlé Crenshaw), meaning that the more marginalized identities a person holds, the more oppression they experience. A wealthy White, gay man, for example, is far less likely to experience as much discrimination and threats of violence as a disabled, Black, trans woman. Even microaggressions, when you consider the toll they take when repeated for years, jeopardize one’s sense of safety in the world. Death by a thousand paper cuts so to speak.
The field is increasingly recognizing Race-Based Traumatic Stress (RBTS) as trauma. Which is defined as the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes. Traumatic stress based in sexism, fatphobia, classism, religious persecution, transphobia, heterosexism, ableism, etc. are conceptualized in the same way. Thanks to the decades-long (or longer) activism by members of these marginalized groups, oppression is increasingly being recognized as the trauma that it is.
What About PTSD Symptoms in Women?
PTSD stands for post-traumatic stress disorder and is the main mental health diagnosis people associate with trauma. A diagnosis of PTSD requires exposure to a trauma as defined above, along with the following symptoms. You will notice they are organized into four clusters, or groups of related symptoms.
Intrusive PTSD Symptoms in Women
The trauma of the past is intruding on your present (must have a least one of the following for a PTSD diagnosis):
Repeated, unwanted memories of the trauma(s)
Repeated, distressing dreams in which the content and/or the emotions in the dream are related to the trauma(s)
Dissociation, in which the person loses contact with the present moment and feels or acts like the trauma is happening again. At it’s most extreme, the person dissociating may completely lose contact with their present surroundings. Flashbacks are a type of dissociation.
Intense or prolonged psychological distress when faced with internal (such as memories, dreams or feelings) or external (such as people, places, situations, etc) reminders of the trauma(s). Psychological distress refers to distressing thoughts or feelings.
Intense or prolonged physical reactions to internal or external reminders of the trauma(s). Examples include pounding heart, lightheadedness, shortness of breath, pain, tension, nausea, etc..
Avoidance PTSD Symptoms in Women
Persistent avoidance of anything and everything that reminds you of the trauma, that you did not avoid prior to the trauma (must have a least one of the following for a PTSD diagnosis).
Avoidance of internal reminders of the trauma(s), such as memories, thoughts, feelings
Avoidance of external reminders of the trauma(s). This is usually a long list very specific to the person’s traumatic experiences. It can include people who look or act like the person(s) that perpetuated the trauma, similar interactions, places, smells, times of day or year, situations, colors, objects, anything really. The survivor might not even know why they avoid these things, they might just think that they don’t like it. For example, a person who is sexually assaulted by a man they met at a bar for a date might avoid anyone who looks or behaves like that person, men, dating, being alone with a stranger, bars, alcohol, dark places, ride share services, whatever food they ate on the date, sexual intimacy, nudity, looking at their own body, that part of town, being alone at night, just to name a few.
Negative Thoughts & Changes in Mood After Trauma
Negative changes to your mood and thoughts after the trauma (must have a least two of the following for a PTSD diagnosis).
Inability to remember important parts of what happened due to dissociating at the time of the trauma. This is not the same as missing details, but more, large sections of the memory are missing. If the memory is missing because of a head injury, alcohol, or drugs, it does not count, as that explains the memory loss (for example, when people are drugged and then sexually assaulted and can’t remember anything).
Chronic, black and white, all or nothing negative beliefs about the self, other people, or the world. Examples include “I’m damaged goods,” “I’m being punished,” “nobody can be trusted,” “only bad things happen to me,” or “the world is completely dangerous.”
Chronic, distorted beliefs about the cause or consequences of the trauma(s) that lead to blaming the self or others. The key here is distorted- it’s not distorted to blame the person who raped the survivor for the trauma. Examples of beliefs about the cause of the trauma could include “it’s all my fault” or “if my friend hadn’t left me at the bar, I wouldn't have been assaulted.” An example of belief about the consequences of the trauma is “nobody will ever want me because I’m so messed up now” or “I should be able to get over it.”
Persistent negative emotional state including fear, anxiety, panic, anger, guilt, shame, and disgust.
Lack of interest or participation in significant activities like hobbies, work, or socializing
Feeling detached or estranged from other people (not due to a conflict that has nothing to do with the trauma). Clients often describe this as knowing they love and care about another person, but have a hard time feeling it, or feeling like they can only let people in so far, with surface-level interactions.
Frequent difficulty feeling positive emotions such as joy, love, or satisfaction. For example, being at a happy event where everyone is happy, and there’s no identifiable reason you shouldn’t be happy, but you just don’t feel happy like you used to.
Significant Changes in Reactivity & Arousal
This isn’t refering to sexual arousal, but your body being keyed up or on edge (must have a least two of the following for a PTSD diagnosis).
Irritability or angry outbursts over minor things. This is often directed at others or objects in the form of verbal or physical aggression, but it can also be directed at the self and invisible to others.
Reckless or self-destructive behavior such as aggressive driving, self-harm, substance abuse, unprotected sex that is not consistent with your values, etc..
Hypervigilance, which is a constant scanning of your environment looking for signs of danger. Examples include always needing to see the exits, always scanning for suspicious people or sudden movements, inability to relax, and generally being hyperaware of your surroundings. This also includes being hyperaware of even the slightest shift in someone else’s emotional state.
Being easily startled and taking a while to calm down and return to baseline.
Difficulty concentrating or focusing
Regular difficulty sleeping. This could be trouble falling asleep, staying asleep, and/or restless sleep.
What If You Don’t Have All of These Symptoms?
Not everybody has all these symptoms or meets the full criteria for PTSD. However, it is possible to have all of these symptoms. In order to meet the criteria for PTSD, you must have the required number of symptoms for at least a month. Additionally the symptoms must cause significant distress or problems functioning, and the symptoms must not be caused by a substance (drugs/alcohol/medication) or a medical issue. Also please note there are some differences when assessing and diagnosing children.
When someone doesn’t meet the full criteria for PTSD, but they are experiencing some of the symptoms and these symptoms are causing significant distress, the diagnosis of unspecified trauma-related disorder is used. When someone has these symptoms, but it’s within one month of the trauma it is diagnosed as acute distress disorder.
Impact of Trauma
When you think about it, all these trauma and PTSD symptoms make perfect sense. The trauma is so upsetting and disturbing that the survivor is reliving it, which is the brain’s attempt to process the trauma and avoid future trauma. Because it is so upsetting the survivor will try to avoid any and all reminders of the trauma. The more the survivor has to avoid, the smaller their world becomes. In order to avoid trauma reminders and future trauma, the survivor must be hypervigilant of their surroundings and hyper-alert at all times. This is exhausting and leaves people irritable and unable to relax, sleep, or concentrate. With all this going on, it’s no wonder they have chronic negative emotions and ways of thinking.
And if the survivor is constantly dealing with:
being upset by trauma reminders
having their lives and worlds shrink due to having to avoid any reminders of the trauma
have a negative attitude about themselves and others
frequent negative emotions
constantly on edge
sleeping poorly
irritable
can’t focus
They are going to have great difficulty at work/school, taking care of themselves, and in their relationships (with romantic partners, family, friends, children, coworkers, supervisors, etc.). Productivity, pleasure, self-esteem, capacity to trust and feel safe, emotional and physical intimacy, health, and the ability to be present all suffer. This creates even more distress.
Why Do Some Heal Without Needing Women’s Trauma Therapy Treatment but Some Don’t?
Most people recover from trauma after a while, but the question remains.
Why do some people recover from a traumatic experience and move on? Why do others get stuck and need trauma therapy and PTSD treatment?
The truth is, it is not ever anyone’s fault for getting stuck in trauma responses. As I mentioned above, nearly everyone has a strong reaction to trauma and experiences these trauma and PTSD symptoms to some degree. We only call it PTSD when the person gets stuck there and the symptoms cause significant, prolonged distress. In other words, PTSD is not a problem of something being wrong with you. But rather, something blocking the natural healing process that is supposed to take place.
Some of the factors that block healing after trauma include:
Continued exposure to trauma. How on earth are you supposed to be able to calm your nervous system and feel safe and whole again if the trauma is continuing? You must be able to get to safety in order to heal. The more trauma a person has, the more they are at risk for developing PTSD. This is why survivors of ongoing interpersonal abuse (sexual, physical, or emotional) or oppression are at greater risk for PTSD.
The continued threat of trauma. The same holds true even if the trauma never actually happens again, but the threat or possibility of it happening again continues. For example, if you are assaulted by a coworker and continue to have to work with the person, such as with sexual assault that occurs in the military. You have no way of knowing the person won’t do it again, so the threat continues.
Lack of support. Support is essential for recovering from trauma. If you have to experience trauma in isolation or don’t have supportive people in your corner, healing becomes more difficult. Sometimes support takes the form of family and friends and other times it can be beneficial to have a trauma psychologist as part of your support system.
Blaming yourself or being blamed. Blame creates so much guilt and shame and further distorts thinking. Thus making it much harder to access support and find healing.
Avoidance. If you never face your fears, you can’t overcome them. This is the rub with PTSD symptoms in women. Avoidance is part of it, and yet, if you continue to avoid reminders of the trauma, you can’t overcome this fear. It is important to note, this refers to the avoidance of reminders of the trauma that are objectively safe. Say, the memory of the trauma or people who look like the perpetrator but who are not abusive not actual trauma or danger. Avoidance is what keeps PTSD symptoms in women going and growing.
Is PTSD More Common With Certain Traumas?
You may have noticed that the first five factors noted above are much more common with interpersonal trauma such as intimate partner violence, sexual assault or abuse, child abuse, etc. This is the reason why interpersonal trauma is far more likely than combat, natural disasters, medical trauma, accidents, etc., to cause PTSD. This is not to say that these types of traumas aren’t terrible- they absolutely are. But people who experience these types of traumas are less likely to have it happen in isolation, be blamed for their trauma, or have support, and these types of traumas tend to be ongoing.
Not only that, but you can usually (but not always) avoid war, natural disasters, and accidents after experiencing these types of traumas. Unless you move to the wilderness and live off the grid, you can’t avoid relationships, so you are continuously participating in the thing in which you were harmed. Lastly, with interpersonal trauma, the survivor is harmed by a person or persons who were supposed to care for them, so it is both unexpected, unnatural, and a huge betrayal.
Self-Blame & Womens Trauma Therapy Treatment
A trauma survivor is NEVER to blame for their trauma. Period. Even if there were signs of danger, no matter what the survivor is wearing, no matter if they were intoxicated, or engaging in risky behavior. There is zero excuses for violating another person. Even if a person is wandering the streets of downtown Los Angeles naked and wasted in the middle of the night. The appropriate social response after finding a person in this state is to put a coat around them and help them get to safety. Not to victimize them.
Similarly, we all make mistakes, do hurtful things, and engage in ineffective behaviors at times. None of that excuses abuse. There are a thousand ways to respond that do not include abuse.
It Is Never The Trauma Survivors’ Fault.
Also, many people, especially survivors of prior trauma in which they could not stop the harm such as child abuse, are likely to have a freeze response when facing trauma. This is why people often freeze and cannot verbally or physically intervene to try to stop the trauma. It is involuntary, like a reflex. Just because someone does not say no or does not physically fight the perpetrator off does not mean that it is their fault or that it “doesn’t count” as trauma. Again, the appropriate response to a person not being enthusiastic about having sex with you is to stop and check in with them. Do not proceed at all unless they are enthusiastic. Anything else is predatory.
Victim blaming is wrong and it is toxic and it makes it harder for survivors to access women’s trauma therapy treatment.
Also, please remember that hindsight is 20/20. What the survivor knows now, they didn’t know at the time or lacked the context to be able to put the clues together and predict that trauma would happen. Even if they were somehow able to know at the time, that also doesn’t mean they could have prevented it. If it could have been prevented, it would have been. I have never seen this not be the case, even when clients are telling me all the things they believe could have prevented it. There are always additional factors that they are unable to see without the help of a trauma therapist.
How can I heal from trauma?
Ah, to end on a hopeful note! The good news is that healing from trauma is totally possible. But it will likely require the help of an experienced trauma therapist or psychologist. Also, while recovery is possible, a cure is not. This is because we cannot erase your memories. But we can reduce the frequency, intensity, and duration of your PTSD symptoms. As well as teach you tools to manage them, and over time they reduce. After healing, there will always be some sadness or anger when reminded of the trauma. This makes sense because it was a horrible experience. But after healing, it will be mild, pass quickly, and not significantly interfere with living your best life. Trauma therapy and PTSD treatment can help survivors shift from surviving to thriving.
Different Options for Womens Trauma Therapy Treatment
There are many different evidence-based treatments that are effective in treating the effects of trauma. These include EMDR Therapy, Interpersonal Therapy, mindfulness-based interventions, Emotion Focused Therapy (EFT), and several types of Cognitive Behavioral Therapy (CBT). Including Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Cognitive Processing Therapy (CPT), and Prolonged Exposure (PE). I have training and experience in all of these treatments, but there are additional PTSD treatments beyond these. It is important to find both a treatment and a trauma therapist who is a good fit. Any good trauma psychologist should explain to you which womens trauma therapy treatment they recommend and why, the risks and benefits, and answer any questions you may have.
It is important to know that the mother of all evidence-based therapies is known as the common factor. This refers to the factors common to a good relationship with your trauma therapist. In other words, there are several specific trauma and PTSD treatments. But the most effective treatment is delivered by a trauma therapist who is collaborative, supportive, and makes you feel safe. They should be trustworthy and compassionate. This person should also be tailoring trauma therapy to your individual identities (like race, gender, sexual orientation, etc.), values, and goals. The PTSD treatment is only as good as the trauma therapist.
Are You Ready to Find The Right Womens Trauma Therapy Treatment in Los Angeles?
As a trauma psychologist near Los Angeles, I understand how hard and difficult it can be to face the fear that you experience after going through a traumatic event. However, the first step towards healing is to stop avoiding and start processing. At Well Woman Psychology you will find support that is tailored to your unique identity, experiences, and needs. Starting PTSD treatment can be difficult but in the end, you can gain control over your PTSD symptoms.
When you are ready to start the healing process follow these simple steps:
Reach out for a consultation at Well Woman Psychology
Learn more about your trauma therapy options
Face your fears and begin to heal
Other Services We Offer in Los Angeles, California, Virginia, New York, & Washington.
At Well Woman Psychology I am dedicated to helping support you and whatever struggles you face as a woman. That is why I provide therapy for body image issues, sex therapy, EMDR, and individual relationship therapy. As well as counseling for miscarriage, infertility, pregnancy, and new moms. All of my services are offered through online therapy in California, Illinois, and Washington.
About the Author:
Dr. Linda Baggett is a Licensed Psychologist at Well Woman Psychology, serving clients online in California, Illinois, New York, and Washington. She received her PhD in Counseling Psychology from the University of Memphis. As a trauma and PTSD psychologist, she specializes in helping people heal from trauma and learn how to shift from surviving to thriving. She is trained in many evidence-based trauma treatments, including EMDR. She also works with clients where trauma intersects with relationship issues, sexuality, pregnancy loss and miscarriage, birth trauma and postpartum issues, infertility, and body image and size-based oppression.
Disclaimer: This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.